Systemic & Respiratory Symptoms
This section covers the most frequent initial complaints that often present together, focusing on fever and respiratory distress. A systematic approach is crucial to differentiate benign from serious conditions.
Fever (Pyrexia)
Investigate the fever's timeline, characteristics, and associated clues to narrow down the potential causes.
Onset & Duration
- When did it start?
- Sudden or gradual onset?
Pattern & Severity
- Continuous or intermittent?
- Highest recorded temperature?
- Accompanied by chills/rigors?
Associated Symptoms
- Cough, cold, rash, or pain?
- Activity level between spikes?
Key Negatives to Ask
- No neck stiffness or light sensitivity?
- No rash that doesn't fade with pressure?
- No confusion or excessive drowsiness?
Cough
The nature of the cough provides vital clues about the underlying location and cause of irritation in the respiratory tract.
Nature of Cough
- Dry or productive (with phlegm)?
- Color of phlegm?
- Paroxysmal (in bouts)?
- Specific sound (barking, whoop)?
Timing & Triggers
- Worse at night or morning?
- Triggered by feeding or activity?
Key Negatives to Ask
- No bluish discoloration of lips?
- Able to drink/feed without issue?
- No history of choking?
Coryza (Runny Nose)
Details of the nasal discharge can help distinguish between a common cold, allergies, or a sinus infection.
Nature of Discharge
- Watery/clear or thick/colored?
- One or both nostrils?
Associated Symptoms
- Sneezing, itching, or watery eyes?
- Difficulty feeding?
Key Negatives to Ask
- No high fever?
- No difficulty breathing?
Breathing Assessment
Differentiate between rapid breathing (tachypnea) and true difficulty in breathing (dyspnea) by looking for signs of increased respiratory effort.
Fast Breathing (Tachypnea)
- When did it start? Constant or intermittent?
- Is the child tired or lethargic?
- Any bluish color on lips/tongue?
- Is feeding affected?
Difficulty in Breathing (Dyspnea)
- Use of neck/chest muscles?
- In-drawing of ribs or below ribcage?
- Nostril flaring?
- Abnormal sounds (grunt, wheeze, stridor)?
- Able to talk, cry, or feed normally?
Key Negatives to Ask
- No bluish discoloration (cyanosis)?
- Child is alert and responsive?
- No history of choking or foreign body inhalation?
Gastrointestinal Symptoms
Abdominal issues are common in children. The history should focus on differentiating surgical emergencies from common medical conditions like gastroenteritis.
Vomiting
The appearance and timing of vomiting are critical to identify potential obstructions or infections.
Frequency & Volume
- How many times in 24 hrs?
- Small amount or entire feed?
Nature of Vomitus
- Milk/food or bloody?
- Forceful (projectile) or gentle?
Key Negatives to Ask
- No green/yellow (bilious) vomit?
- No severe headache or stiff neck?
- No abdominal distension?
Loose Stools (Diarrhea)
Focus on the stool's characteristics and signs of dehydration, which is the primary risk of diarrhea.
Frequency & Character
- How many times in 24 hrs?
- Watery, pasty, or semi-solid?
- Presence of blood or mucus?
Associated Symptoms
- Vomiting or fever?
- Feeding well?
Key Negatives to Ask
- Still producing tears when crying?
- Wet diapers within the last 6-8 hours?
- No sunken eyes or dry mouth?
Abdominal Pain
A detailed pain history is key. The location, character, and associated symptoms help pinpoint the cause.
Location & Character
- Where is the pain?
- Dull, sharp, or crampy?
- Constant or intermittent?
Aggravating/Relieving Factors
- Worse with food or movement?
- Better after passing stool/gas?
Key Negatives to Ask
- No pain specifically in lower right abdomen?
- Abdomen is soft, not hard/rigid?
- No difficulty walking or jumping?
Neurological Symptoms
Neurological symptoms can be alarming. A precise description of the event from an eyewitness is invaluable for diagnosis and management.
Seizure (Convulsion)
The history of a seizure is a story with a beginning, middle, and end. Capture the details of each phase from an eyewitness to understand the event.
1. Description of Event
- Stiffening or jerking movements?
- One side or whole body?
- Loss of consciousness? How long?
2. Post-Event State
- Sleepy or confused afterward?
- Returned to normal quickly?
3. Key Negatives to Ask
- No recent head injury?
- No known ingestion of toxins?
- Child returned to their normal self?
Headache
Look for red flags in the headache history that might suggest increased intracranial pressure or other serious causes.
Character & Severity
- Location: Front, back, or one-sided?
- Type: Throbbing, pounding, or dull?
- Does it affect daily activities?
Key Negatives to Ask
- No vomiting, especially in the morning?
- No changes in vision or balance?
- Headache does not wake child from sleep?
Altered Sensorium
Quantify the change in consciousness. Is the child drowsy, confused, irritable, or completely unresponsive?
Description of Change
- How are they different from usual?
- Difficult to wake up (drowsy)?
- Not recognizing surroundings (confused)?
- Unusually irritable or agitated?
- Unresponsive?
Key Negatives to Ask
- No recent head injury?
- No known ingestion of medication/toxins?
- No preceding fever or headache?
Other Common Presentations
This section covers other frequent complaints that require specific lines of questioning to uncover the underlying cause, from skin manifestations to localized pain.
Skin Rash
Describe the rash's appearance, location, and progression. Note any itchiness or associated systemic symptoms.
Appearance & Distribution
- When did it appear? Where did it start?
- Flat, raised, bumpy, or blisters?
Associated Symptoms
- Is it itchy or painful?
- Any fever or joint pain?
Key Negatives to Ask
- Rash blanches (fades) with pressure?
- No blisters in mouth or eyes?
- Child is otherwise well and active?
Ear Pain
For pre-verbal children, look for non-verbal cues. Inquire about discharge and recent upper respiratory infections.
Characteristics
- One ear or both?
- Child pulling at their ear?
- Any fluid or discharge?
Associated Symptoms
- Recent cold, cough, or fever?
- Any difficulty hearing?
Key Negatives to Ask
- No swelling or redness behind the ear?
- No high, persistent fever?
Sore Throat
Difficulty swallowing is a key sign. Assess for signs of significant airway obstruction or systemic illness.
Severity & Signs
- Refusing to eat or drink?
- Muffled or changed voice?
Associated Symptoms
- Fever, headache, or stomach ache?
- Any rash on the body?
Key Negatives to Ask
- No drooling or difficulty breathing?
- Able to swallow liquids?
- Neck is not stiff?
Urinary Issues
Changes in urination habits can indicate a urinary tract infection, which may present non-specifically in children.
Urination Changes
- Pain or crying during urination?
- Urinating more frequently?
- Sudden new onset of bedwetting?
Associated Symptoms
- Foul-smelling or cloudy urine?
- Abdominal or lower back pain?
Key Negatives to Ask
- No high fever or vomiting?
- Child is feeding well?